Spotlight Interview: Exempla Saint Joseph Hospital

Exempla Saint Joseph Hospital (ESJH) is a 565-bed hospital founded in 1873 by the Sisters of Charity of Leavenworth, Kansas. As the first private hospital in Colorado, located in the heart of Denver, ESJH is the flagship of the three Exempla Healthcare hospitals located in the Denver area. Exempla Lutheran Medical Center (ELMC) and Exempla Good Samaritan Medical Centers (EGSMC) are now all part of the Sisters of Charity of Leavenworth Healthcare System (SCLHS). ESJH and EGSMC have an active partnership with the physicians from the Colorado Permanente Medical Group as well as community and hospital physicians.

In 2012 and 2013, Healthgrades recognized ESJH as a Distinguished Hospital for Clinical Excellence, placing us in the top five percent of hospitals nationwide for clinical performance. 

ESJH was also awarded one of America’s 100 Best Hospitals of Cardiac Care and Cardiac Surgery in 2012 and 2013. ESJH takes great pride in its Cardiovascular Services (CVS), including its Cardiac Electrophysiology program.

What is the size of your EP lab facility?

Building on its legacy of 140 years of health and healing in the community, ESJH has embarked on a major project called the Heritage Project. It will revitalize its downtown Denver campus and create the newest, most modern hospital in Colorado. The new facility will open at the end of 2014 and feature three state-of-the-art dedicated EP labs. 

In the past year we have gone from one fully dedicated EP lab to two. Under construction are two biplane labs with the most up-to-date GE/Prucka CardioLab monitoring systems as well as Biosense Webster’s Carto 3D mapping systems. The third laboratory under construction will include additional technology that will reduce radiation exposure for lengthy procedures. We also utilize a state-of-the-art hybrid OR suite for high-risk implants, and soon for laser lead extractions and left atrial appendage occlusions.

What is the mix of credentials at your lab? Are staff members encouraged to take the registry exam for Registered Cardiac Electrophysiology Specialists (RCES)?

We have five electrophysiologists who practice regularly in our lab. Four are physicians from the Colorado Permanente Medical Group, and one is an employed physician. Our staff consists of five EP monitoring personnel and two dedicated EP nurses. We have diverse backgrounds ranging from RCIS, RT, RN, and Paramedic. In the past year the SCLHS added RCES to the certification matrix recognizing and rewarding this as a specialty. The hospital will cover the cost of the examination and pay an hourly incentive.

What types of continuing education (CE) opportunities are provided to staff members?

For continued education, the EP lead and unit educator coordinate with each of the vendors to provide both on-site and off-site CE opportunities. We schedule one morning CRM in-service for all CVS staff and one advanced off-site EP or CRM CE specifically for the EP team per month. We are fortunate in that our physicians will occasionally provide presentations and case reviews with the EP team as well.

What types of procedures are performed at your facility? Approximately how many are performed each week? 

We share implantation of CRM throughout the CVS department. We offer a wide range of EP procedures, averaging approximately seven EP cases and ten CRM implants per week. We perform diagnostic EP procedures and multiple ablation procedures for arrhythmias including atrial tachycardia, AVRT, AVNRT, atrial flutter, atrial fibrillation (paroxysmal and persistent), ischemic and non-ischemic ventricular tachycardia, and both endocardial and epicardial approaches. We use electrogram monitoring, intracardiac ultrasound and three-dimensional mapping for our diagnostics, and perform therapy with radiofrequency ablation and cryoablation technology.

Who manages your EP lab?

The department director is Jon Hoomes, ARRT. He is responsible for all cardiovascular services, including the CV, IR, EP, and hybrid OR labs. We have interdepartmental leads or shift specialty coordinators (SSC) that assist in the day-to-day operations as well as provide technical resource for our specialties. There is also a dedicated CVS educator and EP Medical Director.

How is shift coverage managed? Also, how does your lab handle call time for staff members? 

Our EP team works four ten-hour shifts with a revolving day off and no call. When EP and CRM procedures run late, the EP team will stay until the procedure is complete. We encourage departmental DT or downtime that allows staff to voluntarily leave early when procedures and ancillary responsibilities are completed early. This helps compensate for the days when procedures run long as well as to avoid mandatory DT.

We are treated as colleagues by our EP physicians and valued as an integral part of the procedure. Our physicians operate the catheters while the monitoring staff stimulates and monitors. We have a scrub assist that breaks once catheters are in place, and most of our EP cases utilize an anesthesiologist with an RN circulator for support.

Who handles your procedure scheduling?

Our procedure scheduling involves numerous personnel due to multiple physicians, physician groups, shared staff, lab availability and anesthesia availability. I maintain a separate EP schedule to track EP/CRM procedures. This helps staff, physicians and vendors visualize our dynamic schedule and room availability. We utilize a CVS Room Charge that is responsible for managing the daily schedule for all procedures. When there are questions concerning specific case requirements (i.e., special equipment, appropriate laboratory and staff availability), the room charge consults with the specific lead for that procedure.

In what ways have you improved efficiencies in patient through-put?

To ensure timely case starts and turnover, we predominately rely on EP staff to prepare and transfer our patients prior to procedure. Our goal is to have the patient in the room to begin set-up 45 minutes prior for an EPS and 30 minutes prior for CRM. We perform patient preoperative preparations in the pre and post unit or patient room if they are an inpatient. For EPS we attach the 12-lead electrodes, and for CRM implants we perform a pre-surgical scrub prior to bringing the patient to the laboratory. This allows us to have a few minutes with the patient and family, reduces the potential for infection, and provides more comfort to the patient as the laboratories are very cool. This also minimizes delays in transport. 

How is inventory managed at your EP lab? Who handles the purchasing of equipment and supplies?

Our CVS supplies are managed by an intradepartmental materials manager. Our director works with system-wide purchasing agents to negotiate equipment costs and contracts. We have developed spreadsheets and macros to assist inventory management and PAR levels. We use GE Healthcare’s Centricity Cardiology Inventory Management Module via MacLab/CardioLab utilizing bar coding technology. We have developed bar code tracking that allows scanning of all EP equipment.

What measures has your EP lab implemented in order to cut or contain costs? 

To help reduce waste and improve efficiency, we have developed physician and procedure protocols and preference sheets. Each EP and CRM procedure is described by type and physician preferences. This includes product descriptions and part numbers for pre-procedure preparation, intraprocedural specifics like sheath size and location, sequence of catheter approach and stimulation protocols, transseptal approach, etc. Dedicated EP staff as well as CV staff who are assigned to assist for a day can refer to these resources to ensure the proper equipment is pulled prior to the procedure and then doublechecked before opening. We utilize reprocessing of equipment whenever practical and reliable. The Sisters of Charity of Leavenworth Healthcare System (SCLHS) consist of multiple hospitals throughout the west and work together to negotiate system-wide savings. 

Tell us about your city or general regional area. 

Denver is the largest city and capitol of Colorado. It located in the South Platte River Valley on the western edge of the High Plains just east of the Front Range of the Rocky Mountains. Denver is nicknamed the Mile-High City because its official elevation is exactly one mile or 5,280 feet above sea level, making it one of the highest major cities in the United States. The 2011 estimated population of Denver was 619,968, which ranks it as the 23rd most populous U.S. city. The 12-county Denver-Aurora-Boulder Combined Statistical Area had an estimated 2011 population of 3,157,520, which ranks as the 16th most populous U.S. metropolitan area.

Only twelve miles from the foothills of the Rocky Mountains makes Denver an outdoor enthusiast’s dream. Moderate temperatures and four seasons offer a variety of outdoor sports. Fishing, hunting, hiking, camping, mountain biking, road biking, motorcycling, rafting, kayaking, rock and ice climbing, skiing and snowboarding are many of the sports available here in the Rocky Mountains regions. Many people choose to live in Colorado for the quality of life it offers as well as the family-friendly values. 

Is there anything else you’d like to add?

The culture at Saint Joseph and in the EP lab is one of the things that make it a great place to work. It is a collaborative environment where staff is involved in decisions that affect them, and doors are open. Most of us at ESJH love to work hard and play hard. We take pride in all that we do. EP has advanced so much in the past 30 years, and ESJH EP has advanced significantly in the past decade — imagine where we’ll be in another decade!